Sd Eform 0889 - Malt Beverage Tax Report

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SD EForm - 0889

South Dakota Department of Revenue

Malt Beverage Tax Report

Mail To: Special Tax Division, Department of Revenue, 445 E Capitol Ave, Pierre, SD 57501

Name: _______________________________________________ License No: __________________________

Address: ______________________________________________ Month of: ___________________________

City & State: __________________________________________Phone Number: ________________________

(Zip Code)

Part A

Malt Beverages

31 Gallon Barrels

INVENTORY (beginning of month)

INVENTORY (end of month)

SALES DURING MONTH (Barrels)

RECEIPTS AND IMPORTS

DEDUCTIONS

a. Returned to Manufacturer

b. Breakage - (carrier, warehouse & delivery)

c. Tax Paid Purchases

TOTAL DEDUCTIONS Total of 5 a, b, & c

NET TAXABLE BBLS. (line 4 minus line 6)

Part B - Tax Computation:

Malt Beverage (from Line 7)

0.00

_____________Bbls. x $8.50 = . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_________________________________

Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_________________________________

Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_________________________________

0.00

Total Tax, Penalty and Interest Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_________________________________

REPORT MUST BE FILED WITH FULL PAYMENT, ON OR BEFORE THE 25TH DAY OF

THE SECOND MONTH FOLLOWING THE REPORTING PERIOD

I declare under the penalty of perjury that this report has been examined by me and to the best of my knowledge and belief is a true,

correct and complete report.

Signature of Licensee______________________________________________________ Date ______________________________

Signature of Preparer_______________________________________________________

(If other than Licensee)

_____________________________________________________________

(For Office Use)

Malt Beverage No. 0086 $_______________________________________